Kerbala is an average size densely populated city, river-sided atAl-Hysannia. Al-Razazah Lake located at west border ofthe province often called buhayrat Al-Razazah which considered to be the secondlargest lake in Iraq and listed as a wetland of international importance.
(5)Table1, Figure 3 and 4consolidate that tendency of infection is much greater in highly populatedresidential areas of the province at central Kerbala as represents more thanhalf of the total cases. Increase in population density can strain existingsanitation systems, thus putting people at increased risk of contractingcholera. (6, 7)This high rates of choleraincidence at the central part of the region, and low rates at the peripheries; Suchhigh urbanization rate strain existing resources meant for providing bettersanitation systems and potable water. Inadequate sanitation systems coupledwith intermittent supply of pipe borne water in urban communities puts thepopulation at risk of cholera.
Surface water pollution is particularly found tobe worse where rivers pass through urban and overcrowded cities, and thecommonest contamination is from human excreta and sewage (8)21 cases were reported atsuburbs district of Al-Hur, 3 kilometres away from Kerbala’s centre. Thisremarkably represents 31% from the total number of cases which considered beingsignificantly high comparing to the overall community population ofapproximately 7500. (9)The district services are basicand over burdened, and informal housing on agricultural lands is having anegative ecological impact on the area causing health deterioration to thecommunity. The number of confirmed Cholera decreases significantly tojust 9 cases at Al- Jazeerha sub-district.
Due to the cosmopolitan(multi-ethnic) nature of Kerbala as well as the vast number of tourists comingto the city every year make the city at increased risk for cholera. The traditional laws which were used to protect waterbodies form waste and fecal pollution are no longer adhered . Therefore,defecating and dumping of waste in and at the banks of surface water bodies hasbecome a common practice in most urban communities. However, urban inhabitantsresort to such polluted water bodies for various household activities like cookingand washing during periods of water shortage Kerbala existing water and sewage infrastructure, includingtreatment plants and pipe networks, is largely in disrepair. Insufficientoperating budgets are exacerbated by poorly trained personnel, unreliableelectricity, and a tendency to look for quick fixes rather than long-termsolutions to problems.(10)